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Protective Effects of Circumcision Explored

Protective Effects of Circumcision Explored

October 01, 2002

ORLANDOUncircumcised men are at increased risk of HIV infection. A new
study presented at the 100th Annual Meeting of the American Urological
Association (abstract 111) suggests that this is due to high numbers of HIV
target cells in the foreskin. Carlos R. Estrada, MD, of Rush-Presbyterian-St.
Luke’s Medical Center, Chicago, and his colleagues evaluated 8 pediatric and
6 adult foreskins with and without a history of HIV-1 infection. Cervical
biopsy tissue served as a control.

Using immunohistochemistry and image analysis, the researchers quantified
three cells targeted by HIV: T cells (CD4+), macrophages (CD68+), and
Langerhan’s cells (CD1a+), as well as the HIV coreceptors CCR5 and CXCR4. The
foreskins had high numbers of the three target cell types, compared with the
cervical tissue, with higher proportions in the adult foreskins. Cells
expressing CCR5 predominated, compared with CXCR4 expression.

The tissue specimens were then exposed to HIV-1. Analysis showed that CD4+
T cells and Langerhan’s cells in the inner mucosal surface of the foreskins
were seven times more susceptible to HIV infection than cells in the cervical
tissue.

"Increased risk of HIV-1 infection in uncircumcised men is likely caused
by the presence in the foreskin of large numbers of HIV-1 target cells,
especially T cells and Langerhan’s cells, expressing primarily CCR5," Dr.
Estrada said. "Since uncircumcised men are likely at greater biological risk
of heterosexual HIV-1 acquisition, male circumcision should be considered as
an additional HIV protection strategy."

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